A General Guide to Running Injuries — and what a good Physical Therapist can do to help

Physical Therapy Procedure. New Heights Physical Therapy in Vancouver WA and Portland OR.

Trent Corey Physical Therapist Vancouver WA

By Trent Corey, PT, DPT     New Heights Physical Therapy Plus, Vancouver, WA

In the line of work that I do, I am very fortunate to be able to treat people who have a variety of physical ailments, ranging from ankle sprains and lower back pain to cervical whiplash.  Though all of my patients bring a set of challenges, there is something very different about the runners that I treat.  As I myself have been a runner for over 20 years, with much of that time spent injured, I know how hard it is when an injury prevents me from getting out on the trail or roads.

It is estimated that 82% of all runners suffer injuries during their running career.   Though I don’t claim to know everything about the subject of running injuries and mechanics, I certainly know enough to help most of my runners get back to full capacity.  Here are a few “take home” tips that if each injured runner actually listened to and followed, would significantly reduce the number of commonly occurring running injuries.

  • Pay attention to what got you injured. 

    This may sound elementary, but some runners actually have no idea what they did that brought them to my clinic.  Usually it’s due to a “Training Error”, a term that basically means too much too soon: Ramping up speed, distance, or both at a rate their body was unable to handle.

  • Back off the running for a little while.

    Focus more on your imbalances, muscle weakness and tightness instead of plugging along on the same old run.  I frequently see people continue to run the same distance and pace, wondering why they aren’t getting any better.   Now, if you do not hurt during or after your run, or things are not getting worse with longer runs, then fine, you are on the right path.  However, there is an element of addiction in running (and other endurance sports) that is unlike anything I’ve seen with other injuries.  Runners need their fix, and no matter how often I tell them to slow down or cut back, they keep coming back for more of the very thing that injured them in the first place.  A physical therapy evaluation will identify patterns to work on; the key is to replace the old habits with new ones that make you stronger and more aligned as a runner, so you will be able to run for the months and years ahead.  Isn’t that worth a brief decrease in mileage in the short term?

  • Get your hips and butt working for you.

    I would say that about 90% of the runners I treat have weakness and/or tightness in the hips (usually both). This compromises your ability to stand on one leg as you transfer your weight forward during gait.  There is a great article about this in the April 2014 issue of Running Times magazine. I have an awesome routine that I give to patients that will get those butt muscles firing, as well as get all major muscle groups lengthened such as hip flexors, gluteals, adductors, quads, and hamstrings.

  • Do your core work. 

    I don’t care if it’s Pilates, Yoga, planks, or P90X, this is a crucial part of stability in gait.  If you are weak in your core, then you set yourself up for a whole host of problems throughout your system.  We need to start thinking of ourselves as athletes, not just sedentary people who run.   My runners get a healthy serving of core stability exercises that start from the most basic “neutral spine” positions to more dynamic stability movements on the ball, foam roller, or other unstable surfaces.

  • Get better at standing on one foot.

    I heard once from an online running coach that all runners should be able to stand on one leg for at least 3 minutes.  Try it.  It’s hard to do if your feet and hips are not strong.  Also, it’s amazing how bad people’s awareness of their bodies are, especially the injured ones.  Practice single leg balance for at least 2 minutes while brushing your teeth is a great way to improve body awareness and alignment for running.

  • Check yourself out on video.  

    This doesn’t have to be complicated, and since having a video camera is so common, it’s very easy to capture.  All you need is about 30 seconds (or less) of running at normal pace viewed from the side and from the back. Even without training in biomechanics, you are usually able to see things about your stride that don’t look quite right.  By doing the exercises and body focuses that we work on in therapy, you can recheck your form again in a month or so to see if you notice a difference.  Of course, we also do some basic video analysis in the clinic using an iPad so you can see what we see in your stride and what needs work.  A  good article about this was written in the Jan/Feb 2011 issue of Running Times.

IMG_0056_448w

  • Feel the Chi:

    I highly recommend the book Chi Running, by Danny Dreyer. Its simple approach to running stride is less about force and more about flow.  The basics include posture focuses such as leveling your pelvis, then leaning yourself forward while picking your feet quickly off the ground, not pressing.  The stride rate, or number of strides per minute is usually more than you’re used to, but it helps take pressure off the muscles and joints, since you are using gravity to pull you into a controlled fall forward.  These are just the basic concepts, but it can help you run further with much less effort.  Chi Running also has an App on iPhone that you can use to get your mind around this new concept.

  • ASTYM: 

    Runners who develop chronic tendonitis (now officially classified as a tendonosis), may benefit from a type of therapy called ASTYM.   Tendonosis is the break down in connective tissue strength and elasticity due to repetitive loading and inflammation cycles.  ASTYM uses special instruments to help stimulate growth factors in chronically inflamed and scarred down tissues, helping to remodel new tissue growth that will be stronger once healed.  What’s great about ASTYM to runners is that it is important to exercise regularly to load the tissue, because this helps your body to stimulate a new stronger tendon or muscle.Astym Therapy For Improving Running Performance - New Heights Physical Therapy - Portland OR Vancouver WA

  • Work out your tissue yourself. 

    ASTYM can be painful, but very effective, and so is massage if you can afford to go regularly. Another tool to become familiar with and use frequently is a foam roller.  In general, the more sensitive an area is, such as your calf or butt muscle, the more you need to massage it.NewHeights0312sm-11-300x207

  • Persistence, persistence, persistence!!!! 

    One of my greatest challenges as a physical therapist is managing patients’ expectations about recovering from an injury.  When patients come back after a week or two, or even at the second visit, and wonder why they aren’t any better, I usually remind them that this problem has been brewing for quite a while so a couple of quick exercises will not be enough to snap them right into perfect running form with no more injuries.  There are important things that must be done in therapy, and it takes up to   6000 repetitions of any movement for it to become ingrained as a habit without conscious focus. Keep in mind the three goals of therapy: To improve muscle strength and flexibility, develop balance in the right places,   and most importantly, train your nervous system to work correctly by feeling the optimal way to put one foot in front of the other.  This is like running to the horizon—you may never get to the ideal, but keep working at it by tuning into your body.  Your body will be glad you put the effort in to gain healthy new habits to keep you running for a long time.

Recommended reading:

Anatomy for Runners, by Jay Dicharry, MPT

The Runner’s Guide to Yoga, by Sage Rountree

www.chirunning.com

 

 

Low Back Pain: Treatment Considerations

by Maureen Lefere, PT, ASTYM Certified

Maureen Lefere

Low back pain, or LBP, is something most people will experience at some point in their lives.   In fact, 50% of working Americans will have back pain during their career.  It is the leading cause of disability in Americans under 45 years of age, it costs employers $7.4 BILLION dollars a year, and it is the third most expensive health condition in the US, second only to cancer and heart disease.  The costs in decreased quality of life, family disruption, depression, and general health are immeasurable.  If you are the person suffering from low back pain, the statistics don’t mean much, you just want a solution.    

There are many different approaches to treating low back pain and unfortunately,  no universal solution that works for everyone.  A research study performed in 1994 looked at 98 people with no complaints of LBP.  They completed MRIs on all individuals and found that 52% of these patients did in fact have positive disc bulges in their lumbar spines.  This demonstrates that a positive finding on an MRI, x-ray, or CT scan does not mean it will always be associated with pain.  In addition, several studies have shown the same statistical decrease in disability in individuals who underwent a lumbar fusion vs. those who received back care education and exercises.

lbp

So, how does one decide how to treat their low back pain?

Number one:  recognize that if this is your first injury, there is a very good chance that you will spontaneously recover without professional intervention.    We have a wonderful mechanism in our body called homeostasis where our body is always trying to restore itself to normalcy.    Often, just having this knowledge will decrease the stress response  which will often decrease the pain response without intervention.

Second, don’t stop moving.   The human body heals by moving white blood cells into damaged tissue, and then removing waste.   With immobilization comes stasis, or stagnation,  of fluid, swelling, muscle inhibition, and nerve irritation.    That does not mean continue doing activities that increase pain, but rest combined with graded, low intensity movement is best for promoting healing.   

Third, evaluate if you need a health care professional’s guidance.    When back pain is accompanied by leg symptoms such as numbness and burning, you should seek medical attention.    If back pain is accompanied by urinary frequency or loss of control of the bladder, you should go to the ER.    If back pain has not improved in one to two weeks with ice, rest, graded movement, and over the counter medication, you should see your health care professional.   

WHO TO SEE?   

There are many people who can help with your back.  Since I am a PT, I am going to share what we do.    This doesn’t mean there aren’t other professionals who can help you.    The questions that you should expect ANY provider to answer are:

  1. What do they believe is the primary problem?
  2. What will the provider do to address your problem?  
  3. Approximately how long does the provider expect to see you?   This is sometimes a difficult question as back pain is complicated, but the provider should be able to give you a general idea.  

Physical therapists will conduct a thorough evaluation which will include looking at range of motion, strength, posture, neurological function, general tissue health, and endurance.     They will ask you about your pain, your past medical history, current medications, level of activity, sleep, work, and what your specific goals are. 

Therapists evaluate the entire system and may find areas of involvement away from your low back including your feet, hips, neck, or mid back.   Once the therapist has completed their examination, they will explain why you are having pain, their treatment plan, any precautions you may need to take to prevent re-injury, and will give you specific instructions for what you can do at home to manage your condition.    

This piece, to help you to self-manage your condition, is crucial to the long term success of your treatment.     Therapists empower patients with knowledge so that patients can treat themselves.    In this way, you are in charge of your health, and not dependent on a practioner or technique for pain relief.   

In the initial stages of therapy, when the primary goal is to decrease pain, therapists will use a variety of techniques, each specific to your condition.    These may include:

  • manual therapy techniques, such as  joint mobilization/manipulation if you have a segment or segments that are not moving functionally or to promote fluid movement within a joint
  • soft-tissue mobilization, to address muscle and fascia restrictions and to allow optimal muscle function
  • nerve mobilization, to improve circulation and mobility in the nervous system itself
  • microcurrent, to decrease inflammation and speed healing
  • exercise, initially to improve circulation and facilitate endorphins and to prevent muscle atrophy and promote normal movement patterns.     

Exercise can also be used to restore range of movement (ROM) and to inhibit pain.  As your pain decreases, exercise becomes even more important as you re-build strength and endurance in the muscles that stabilize your spine and work on specific functional activities for your work and home life.    

STEP

Therapists at New Heights use primarily the STEP exercise concept which stands for Scientific Therapeutic Exercise Progressions.   This involves dosing your exercise regimen to the specific tissue that is injured as well as using appropriate resistance to the stage of recovery that you are in.     There is considerable evidence to support the STEP concepts and many times patients are surprised that they do not have a significant increase in soreness during or after exercise, in fact most often they have less pain.    

In addition to hands on treatment and exercise, your therapist will also communicate with other health care professionals on your team, make suggestions for additional resources (for example, nutritionists, chiropractors, acupuncturists, naturopaths, and physician specialists ) if needed, and communicate with your workman’s compensation representative if your injury occurred on the job.    

During your course of treatment, your therapists will be updating your home program and when you complete therapy you will have all the information you need to prevent re-injury and to maintain your low back health and function.    Your therapist will also provide their email information for future questions.    

A physical therapist’s primary purpose is to help your body return to the most optimal state possible and to restore the majority of your pre-injury function.   Our job is to make you not need us, and we are pretty good at it!!    A back injury or chronic low back pain does not need to be a lifelong condition, appropriate care and your commitment to your home program is the key to solving this common injury.   

Maureen “Mo” Lefere, PT , ASTYM Certified, works at New Heights Physical Therapy Plus, Vancouver Clinic 

Guest Blog: PRP (Platelet Rich Plasma): Why the Buzz?

Guest Blog: by Dr. Russ Riggs, Reflex Clinic

Reflex Tag

If you’ve ever injured a knee, Achilles, or anything that involves movement, you know that healing can be a long, drawn out process, especially if you had to get surgery. During that time you’re in pain, inconvenienced, and just wish it would end. Well, if you’re someone that doesn’t want to experience that long wait again, there’s good news: a new treatment has arrived called platelet rich plasma therapy. Doctors claim that it can speed up the healing process by manipulating your body’s own restorative abilities. You probably know the process better as PRP.

What Injuries Can PRP Be Used For?

The limit to which injuries and diseases PRP therapy can treat have yet to be found. Currently there are studies that support its use for treating a whole bevy of ailments. PRP is rapidly emerging as a treatment for ACL and MCL injuries such as tears, knee pain, osteoarthritis of the knee, spine injuries, rotator cuff tears, pelvic pain, jumper’s knee, back and neck injuries, and tennis elbow.

As PRP therapy is a fairly new treatment here in the United States, there aren’t as many studies as experts would like. Within the next few years we expect to see several randomized, blinded, placebo controlled studies to give the treatment more validity. However, there have been several cohort studies – as well as anecdotal evidence –that’s showed the treatment is effective. Based on the success we’ve seen with our patients we expect this treatment to grow in popularity rapidly over the next couple years.

Effectiveness

A lot of high priced athletes who make a living from the health of their bodies swear by the treatment. Tiger Woods received four injections of PRP therapy after knee surgery in 2009, and Kobe Bryant went all the way to Germany for a similar treatment in 2013. The reason Bryant – and other stars like New York Yankees’ Alex Rodriguez – go to Germany for treatment is because the United States Food and Drug Administration says that any procedure like PRP can only be used minimally, whereas places like Germany allow a more enhanced experience, such as the inclusion of stem cell use.

PRP Explained

PRP therapy is a lot simpler than you might expect. When you go to the doctor’s office for the treatment, a sample of your blood will be drawn from your arm into a vial. The blood is then spun down in a special type of centrifuge that concentrates the blood’s own platelets.

centrifuge PRP

PRP centrifuge imageBlood platelets are an important part of the healing process, they attach to the injury and release growth and healing factors. These are all a part of what our body normally uses to heal injuries.

After the platelets are separated during the spinning process, the doctor will usually use an ultrasound to pinpoint the injury and inject the platelets directly into the injured area.

The patient will then have anywhere between two to eight times more platelets to heal his/her injury with. The treatment is enhancing the body’s own healing process; it’s really just that simple.

Are You A Candidate?

If you’ve failed traditional non-surgical treatments like HA injections or physical therapy and are hoping to avoid surgery, PRP therapy could be just what you need.

PRP can treat injuries to your knee(s) from activities such as playing basketball or football, jogging, weight lifting, or even everyday things like climbing stairs or walking.

You may also want to consider PRP therapy if you have nagging pain from previous injuries like tripping and landing on your knee, or being involved in a car accident. Schedule a PRP consultation with one of our physicians or your primary care doctor to determine if you’re a good candidate for this new procedure.

Risk Factors

PRP therapy uses the patient’s own blood, and because of that there is very little risk for any kind of rejection. Although there are a small amount of patients who may have an adverse reaction to their own blood, it is very rare. Because it is only a simple blood draw and injection, there is no need for anesthesia, opening the wound, or a hospital stay. Highly convenient, the procedure is done in our office, and lasts about an hour.

PRP lab tech centrifuge

Some patients complain about a dull ache in the spot of the injection, and because PRP uses a needle there is always a chance that an artery or vein could be damaged and cause a blood clot. If that happens, the clot is treated like any other clot with blood thinners, but risk factors like these are very low and should always be discussed with your physician before moving forward with the procedure.

If this sounds like something you might be interested in, online chat and message health boards with people who’ve already completed the procedure can give you a firsthand account of their results and are an excellent resource. Also, ask around to see if anyone you know has had it done, you might be surprised. There are a lot of variables – including cost – so you can never ask too many questions. If you live in the Portland area give us a call for any questions you might have about the procedure, and schedule a consultation. Living with knee pain just isn’t worth it, and new treatment options are now available.

Guest Blog: Treatment Options for Knee Osteoarthritis

 Reflex Tag

Guest blog: by Reflex Clinic

According to the CDC one out of every two people in the United States will develop symptomatic knee osteoarthritis (OA) by age 85. Factors such as age, weight, gender, activity level and genetics can increase or decrease the likelihood of developing OA in your lifetime. Although there is no cure for osteoarthritis of the knee, there are more treatment options available than ever before, especially if detected in its early stages.Continue reading

Guest Blog: What Is Hyaluronic Acid And Why Is It Good For You?

Reflex Tag

What is Hyaluronic Acid (HA), and why is it good for you?

If you’re experiencing knee pain, but haven’t injured your knee recently, it could be caused by a depletion of Hyaluronanic acid (HA or Hyaluronan), a naturally-occurring protein in our synovial fluid. Our knee joints are surrounded by the synovial membrane, which forms a capsule around the ends of the articulating leg bones. This membrane secretes a liquid called ‘synovial fluid’, which is mainly comprised of HA. Synovial fluid is a viscous fluid with the consistency of motor oil.

https://www.youtube.com/watch?v=m2qJMbzwA3w

What does HA do?

• It lubricates our joints, making them work more smoothly.
• It is a shock absorber, preventing our bones from bearing the full force of impact when we walk.
• It improves overall cartilage health, flexibility, and mobility.

As we age, the concentration of this protein in our joints decreases and becomes thinner. As a result, it doesn’t cushion our bones as well. This decreased concentration of Hyaluronan in the joint is thought to significantly contribute to the progression of osteoarthritis (chronic joint inflammation with progressive cartilage loss), the most common cause of chronic knee pain.
To counteract the effects of osteoarthritis progression, injections of HA can be administered directly into the affected joint. This has the effect of decreasing inflammation in the joint, improving cartilage health, and potentially preserving existing cartilage. The injections supplement the viscous properties of synovial fluid of the knee, restoring elasticity, lubrication, and mobility of the affected joint. Best of all, HA is highly effective in alleviating chronic knee pain. Hyaluronan injections are FDA approved, safe, and minimally invasive.

What’s the catch?

Accurate placement of the Hyaluronan injection is essential. These injections are generally administered in a series — usually 3 to 4 injections 1-2 weeks apart. If your physician isn’t using ultra-sound or X-ray guidance there is a 30% chance, every time you get an injection, that the needle will not be in the correct spot, meaning you aren’t getting the medicine inside the joint. So, if you’re looking into getting HA injections make sure you find a doctor or clinic that uses X-ray or ultrasound guidance, to ensure the best possible outcome.

Written by the physicians at Reflex Portland. For more information about Reflex, check out their website! https://www.reflexknees.com/

Why Choose Physical Therapy?

Injuries from a car accident can be extremely stressful, burdensome and painful. The pain from your injuries can interfere with your day to day life and progress over time, which is why it is essential to initiate care as soon as possible. When evaluating care options, you may wonder what type of care will best relieve your acute pain, as well as yield permanent relief in the long run. Research shows that there are many benefits to initiating physical therapy care within 96 hours after you are in a motor vehicle accident.

whiplash treatment portland oregon

WHY CHOOSE PHYSICAL THERAPY?

  • At New Heights Physical Therapy Plus, our therapists always perform a thorough examination of your injuries and determine the best course of action to provide the most beneficial symptom relief. They gather information about your medical history, the type and severity of the accident, and other types of treatment you are receiving in conjunction with your physical therapy to determine what treatments, exercises, and modalities will be most helpful with your healing.
    • Acute treatment may include manual therapies (which may include manipulations, strain-counterstrain, or other hands-on techniques), light pumping exercises, and/or microcurrent.
    • Long term treatment may include manual therapies and/or specific strengthening exercises to decrease long term discomfort.
    • Studies have shown that physical therapy is effective in treating whiplash injuries because it prescribes active treatment which includes physical therapy evaluation, posture control, neck rotation and pumping exercises, strengthening exercises, and other treatments depending on the needs of the patient.  Again, for best treatment results, active care ideally begins within 96 hours of the accident.
    • Whether your injuries are joint, muscle, neurological, whiplash or vestibular-ocular we are prepared to treat you quickly and efficiently.

NewHeights0312sm-37

EXPERIENCE YOU CAN RELY ON

Our senior physical therapists have an average of more than fifteen years clinical experience with a wide range of continuing education. We have extensive experience in the diagnosis and treatment of whiplash and other auto injuries and are confident we will have you feeling better as soon as possible.